Weill/Cornell Medical College, New York, NY, USA.
AIDS Behav. 2010 Aug;14(4):794-8. doi: 10.1007/s10461-009-9663-6.
In resource-constrained settings, the most frequently cited barrier to optimal antiretroviral therapy (ART) adherence among HIV-infected patients has been the cost of medications. In recent years many subsidized medication programs have been developed to improve ART affordability. A Graduated Cost Recovery program at the largest care center in South India has enrolled 839 eligible patients into four tiers based on an evaluation of their financial information and willingness to pay, of these patients 635 consented to participate in this study. Patients in Tier 1 receive first-line ART at no cost, whereas patients in Tiers 2, 3, and 4 pay 50, 75, and 100%, respectively of the cost of first-line medications based on an assessment of their means. Adherence rates of 95% or greater on 3-day recall were achieved by 84.6% of Tier 1 (n = 156), 71.6% of Tier 2 (n = 141), 72.3% of Tier 3 (n = 242), and 79.2% of Tier 4 (n = 96). These findings suggest patients are highly motivated and that the provision of no-cost ART can promote higher rates of optimal adherence.
在资源有限的情况下，艾滋病毒感染者接受最佳抗逆转录病毒疗法 (ART) 的最常被提及的障碍是药物费用。近年来，许多补贴药物方案已经开发出来，以提高 ART 的可负担性。印度南部最大的护理中心实施了分级成本回收方案，根据患者的财务信息和支付意愿，将 839 名符合条件的患者分为四个层次，其中 635 名患者同意参与这项研究。第 1 层的患者免费获得一线 ART，而第 2、3 和 4 层的患者则根据其经济状况，分别支付一线药物费用的 50%、75%和 100%。在 3 天回顾中，第 1 层（n = 156）、第 2 层（n = 141）、第 3 层（n = 242）和第 4 层（n = 96）的患者分别有 84.6%、71.6%、72.3%和 79.2%的患者达到了 95%或更高的依从率。这些发现表明患者积极性很高，提供免费的 ART 可以促进更高的最佳依从率。
